<script>
	function submitForm() {
		document.getElementById("showtime_id").value = <?php echo $info['showtime']; ?>;
		document.getElementById("seat_id").value = <?php echo $info['seat']; ?>;
	}
</script>

<form class="form-horizontal" action="insert_payment_info" method="post">
<fieldset>
<div class="row">
			
	<div class="span3">
		<ul class="thumbnails">
			<li class="span3">
				<div class="thumbnail">
					<!--<img data-src="chairs.jpg" alt="">-->
					<h3>Payment</h3>
					<p>Fill in the form for a credit card payment.</p>
				</div>
			</li> 
		</ul>
	</div>	
		
	
	
	<div class="span5">
		<div class="control-group">
			<label class="control-label" for="inFirstName">First Name</label>
			<div class="controls">
				<input type="text" pattern="[A-Za-z0-9]{1,}" title="At least one letter and/or number" 
					id="inFirstName" name="inFirstName"
					placeholder="First Name" required>
			</div>
		</div>
			
		<div class="control-group">
			<label class="control-label" for="inLastName">Last Name</label>
			<div class="controls">
				<input type="text" pattern="[A-Za-z0-9]{1,}" title="At least one letter and/or number"
				 	id="inLastName" name="inLastName"
					placeholder="Last Name" required>
			</div>
		</div>
			
		<div class="control-group">
			<label class="control-label" for="inCreditCard">Credit Card #</label>
			<div class="controls">
				<input type="text" pattern="[0-9]{16}" title="Must be 16 numbers" 
					maxlength="16" id="inCreditCard" name="inCreditCard"
					placeholder="xxxxxxxxxxxxxxxx" required>
			</div>
		</div>
	
		<div class="control-group">
			<lable class="control-label" for="expire">Expiry Date</lable>
			<div class="controls">
					<input type="text" pattern="[0-9]{4}" title="Must be 4 numbers" 
						maxlength="4" id="inDate" name="inDate" placeholder="MMYY" required> 
				</div>
			</div>
		</div>
		
		<div class="span 4">		      
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_first</p>"; ?>  
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_last</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_ccn</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_cce</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_lenccn</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_lencce</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_numccn</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_numcce</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_mm</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_yy</p>"; ?>
			<?php if(isset($error) && ($error)) echo "<p>$errormsg_trans</p>"; ?>
		</div>
		
	</div><!-- close span -->
</div><!-- close row -->

<div class="row">
	<div class="span1 offset11">
		<button type="submit" class="btn btn-large btn-inverse" onClick="submitForm()">Next</button>
	</div>
</div>

	<input type="hidden" name="showtimeId" id="showtime_id" value="" />
	<input type="hidden" name="seatId" id="seat_id" value="" />
</fieldset>
</form>

